Methods and systems for generating thermal bubbles for improved ultrasound imaging and therapy

ABSTRACT

A method and system uniquely capable of generating thermal bubbles for improved ultrasound imaging and therapy. Several embodiments of the method and system contemplates the use of unfocused, focused, or defocused acoustic energy at variable spatial and/or temporal energy settings, in the range of about 1 kHz-100 MHz, and at variable tissue depths. The unique ability to customize acoustic energy output and target a particular region of interest makes possible highly accurate and precise thermal bubble formation. In an embodiment, the energy is acoustic energy. In other embodiments, the energy is photon based energy (e.g., IPL, LED, laser, white light, etc.), or other energy forms, such radio frequency electric currents (including monopolar and bipolar radio-frequency current). In an embodiment, the energy is various combinations of acoustic energy, electromagnetic energy and other energy forms or energy absorbers such as cooling.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority from U.S. ProvisionalNo. 61/293,916 filed Nov. 24, 2009, which is incorporated in itsentirety by reference, herein.

FIELD OF INVENTION

Embodiments of the present invention generally relate to therapeutictreatment systems, and more particularly, to methods and systems forgenerating thermal bubbles for improved ultrasound imaging and therapy.

BACKGROUND

Ultrasound has long been used for diagnostic imaging applications. Morerecently however, several new therapeutic applications for ultrasoundare being discovered.

SUMMARY

Various embodiments of the present invention provide a method and systemuniquely capable of generating thermal bubbles for improved ultrasoundimaging and therapy.

In various embodiments, the physical mechanisms for generating thermalbubbles can comprise one or more of the following: (1) selectiveabsorption of ultrasound energy within a bubbly medium due to enhancedattenuation from scattering; (2) enhanced thermal gradient in amicro-bubble rich region due to enhanced viscous losses from stablecavitation; (3) enhanced thermal response due to ultrasound-gas-vaporvoids; and (4) enhanced deposition of thermal energy from inertialcavitation events.

In various embodiments, providing ultrasound energy to cell membranes ortissues with thermal bubbles ultrasound imaging and therapy. Forexample, in various embodiments, the permeability and/or transparency ofcell membranes can be modulated. For example, in some embodiments, thepermeability and/or transparency of cell membranes is increased. In someembodiments, heating can cause better diffusion of a material or a drugthrough the layers of skin tissue. Cavitation and radiation forceinvolves sustained oscillatory motion of bubbles (aka stable cavitation)and/or rapid growth and collapse of bubbles (aka inertial cavitation).Resulting fluid velocities, shear forces and shock waves can disruptcell membranes or tissues and induce chemical changes in the surroundingmedium. The collapse of bubbles can additionally increase the bubblecore temperature and induce chemical changes in the medium (e.g.,generate highly reactive species, such as free radicals). Each of theabove effects can impact ultrasound imaging and therapy effectiveness.In addition, other ways to impact ultrasound imaging and therapy includemelting or mechanically disrupting thermally sensitive or mechanicallyfragile substances, such as medicant-carrying liposomes and/or otherchemical loaded, gas or liquid filled stabilized spheres, analogous tolocal delivery.

In some embodiments, ultrasound imaging and therapy can be enhanced whenshock waves generated upon collapse of bubbles disrupt the stratumcorneum and thereby enhance skin permeability. Likewise, ultrasoundimaging and therapy effectiveness can be enhanced when shock wavestransiently compromise the integrity of cell membranes or tissues, orwhen local free-radical concentration enhances medicant toxicity.Moreover, certain medicants can be activated and/or released usingenergy. In that regard, a medicant encapsulated in a carrier can bereleased at the site of interest using energy (e.g., acoustic energy).For example, U.S. Pat. No. 6,623,430, entitled “Method and Apparatus forSafely Delivering Medicants to a Region of Tissue Using Imaging, Therapyand Temperature Monitoring Ultrasonic System”, which is herebyincorporated by reference in its entirety.

In various embodiments, a region of interest (or “ROI”) is locatedwithin one of the nonviable epidermis (i.e., the stratum corneum), theviable epidermis, the dermis, the subcutaneous connective tissue andfat, and the muscle. Depths may be in the range of about 0 mm to about 3mm, 5 mm, 8 mm, 10 mm, 25 mm, 60 mm, 80 mm, or 100 mm or more. Inaccordance with various embodiments, the ROI is located about 20 mm toabout 30 mm below the stratum corneum. Further, a plurality of ROI canbe treated, and in some embodiments, simultaneously. For example, theROI may consist of one or more organs or a combination of tissues eithersuperficial or deep within the body.

In various embodiments, the method and system is uniquely capable ofdisrupting cell membranes or tissues and inducing chemical changes inthe surrounding medium at either a single or multiple layers of skintissue simultaneously (e.g., a plurality of depths within a cellmembrane or tissue simultaneously). For example, in one embodiment, onefrequency of acoustic energy at one skin layer might generate shockwaves upon collapse of bubbles to disrupt the stratum corneum andthereby enhance skin permeability. A different frequency of acousticenergy at a different skin layer might simply provide heat to causebetter diffusion of medicants through the layers of skin tissue. Yetanother frequency of acoustic energy at a different skin layer mightcompromise the integrity of cell membranes or tissues, or generate localfree-radicals to enhance or reduce medicant toxicity. In variousembodiments, acoustic energy can be deposited in three-dimensions and atvariable depths to selectively increase tissue permeability to therebysteer or guide the medicant through the tissue to a region of interest.

In various embodiments, the methods and systems disclosed hereincontemplate the use of unfocused, focused, or defocused acoustic energyat variable spatial and/or temporal energy settings, in the range ofabout 1 kHz-100 MHz (e.g. about 1 kHz-50 kHz, 50 kHz-100 kHz, 100kHz-500 kHz, 500 kHz-1 MHz, 3 MHz-7 Mhz, 1 MHz-20 MHz, 1 MHz-10 MHz, 10MHz-50 MHz, and/or 50 MHz-100 MHz, and any ranges or combinations ofranges), and at variable tissue depths. In various embodiments, thetissue depth can include, but are not limited to, 0-1 mm, 1 mm-2 mm, 2mm-3mm, 3 mm-4 mm, 4 mm-5 mm, 5 mm-6 mm, 6 mm-7 mm, 7 mm-8 mm and 8 mmor more, and any ranges or combinations of ranges. The unique ability tocustomize acoustic energy output and target a particular region ofinterest makes possible highly accurate and precise thermal bubbleformation.

In various embodiments, a system comprises a probe, a control system,and a display or indicator system. The probe can comprise various probeand/or transducer configurations. In various embodiments, the probedelivers unfocused, focused, or defocused ultrasound energy to theregion of interest. Imaging and/or monitoring may alternatively becoupled and/or co-housed with a system contemplated by embodiments ofthe present invention.

In various embodiments, the control system and display system can alsooptionally comprise various configurations for controlling probe andsystem functionality, including for example, a microprocessor withsoftware and a plurality of input/output devices, a system forcontrolling electronic and/or mechanical scanning and/or multiplexing oftransducers, a system for power delivery, systems for monitoring,systems for sensing the spatial position of the probe and/ortransducers, and systems for handling user input and recording treatmentresults, among others.

In various embodiments, a system for generating thermal bubbles forimproved ultrasound imaging and therapy includes a control systemconfigured for control of the system, a probe configured for generatingthermal bubbles, and a display system.

In various embodiments, a system for imaging thermal bubbles includes acontrol system configured for control of the system, a probe configuredfor imaging thermal bubbles, and a display system.

In various embodiments, a method for generating thermal bubbles forimproved ultrasound imaging and therapy includes the steps of providinga source of acoustic energy, coupling the acoustic energy to a region ofinterest, and focusing the acoustic energy to the region of interest togenerate thermal bubbles, wherein the source frequency of the acousticenergy is in the range of about 10 kHz to about 30 MHz.

In various embodiments, a method for generating thermal bubbles to evokea cellular response includes the steps of providing a source of acousticenergy, coupling the acoustic energy to a region of interest; andfocusing the acoustic energy to the region of interest to generatethermal bubbles, wherein the source frequency of the acoustic energy isin the range of about 10 kHz to about 30 MHz (e.g., about 10 kHz-50 kHz,50 kHz-100 kHz, 100 kHz-500 kHz, 500 kHz-1 MHz, 1 MHz-10 MHz, and/or 10MHz-30 MHz or overlapping ranges therein), and evoking a cellularresponse. In various embodiments the cellular response comprises one ormore of a wound healing response, an immune histological response,heat-shock protein expression, programmed cell death, wound debridement,keloid/scar healing, and increased localized micro-circulation.

In various embodiments, a method for generating thermal bubbles toaffect a chemical moiety includes the steps of providing a source ofacoustic energy, coupling the acoustic energy to a region of interest;and focusing the acoustic energy to the region of interest to generatethermal bubbles, wherein the source frequency of the acoustic energy isin the range of about 10 kHz to about 30 MHz (e.g., about 10 kHz-50 kHz,50 kHz-100 kHz, 100 kHz-500 kHz, 500 kHz-1 MHz, 1 MHz-10 MHz, and/or 10MHz-30 MHz, or overlapping ranges therein) and evoking an effect on achemical moiety. In various embodiments, the effect includes enhancingthe delivery or augmenting the activation of the chemical moiety.

In various embodiments, a method for optimization of therapy includesconcomitant monitoring of bubble activity by monitoring (a) one or morenon-thermal responses, (b) one or more thermal responses and/or (c) oneor more tissue property changes.

In several embodiments, the systems (and methods thereof) comprise theuse of thermal bubbles in which the source frequency of the acousticenergy is about 1-10 MHz for therapy (e.g., 4 or 7 MHz) and 5-25 MHz forimaging (e.g., 18 MHz).

BRIEF DESCRIPTION OF THE DRAWINGS

The subject matter of various embodiments of the invention isparticularly pointed out in the claims. Various embodiments of theinvention, both as to organization and method of operation, may beunderstood by reference to the following description taken inconjunction with the accompanying drawing figures, in which like partsmay be referred to by like numerals, and:

FIG. 1 illustrates a block diagram of a method for generating thermalbubbles for improved ultrasound imaging and therapy in accordance withvarious embodiments of the present invention;

FIG. 2 illustrates a schematic diagram of a treatment system configuredto generate thermal bubbles in accordance with an various embodiments ofthe present invention;

FIG. 3 illustrates a block diagram of a treatment system in accordancewith various embodiments of the present invention;

FIGS. 4A, 4B, 4C, 4D, and 4E illustrate cross-sectional diagrams of antransducer used in a system in accordance with various embodiments ofthe present invention; and

FIGS. 5A, 5B, and 5C illustrate block diagrams of a control system usedin a system in accordance with various embodiments of the presentinvention.

DETAILED DESCRIPTION

Several embodiments of the present invention may be described herein interms of various functional components and processing steps. It shouldbe appreciated that such components and steps may be realized by anynumber of hardware components configured to perform the specifiedfunctions and processes. For example, various embodiments of the presentinvention may employ various medical treatment devices, visual imagingand display devices, input terminals and the like, which may carry out avariety of functions and processes under the control of one or morecontrol systems or other control devices. In addition, variousembodiments of the present invention may be practiced in any number ofmedical contexts and the embodiments relating to a method and system forgenerating thermal bubbles for improved ultrasound imaging and therapy,as described herein, are merely indicative of embodiments ofapplications for the invention. For example, the principles, featuresand methods discussed may be applied to any medical application.Further, various aspects of embodiments of the present invention may besuitably applied to other applications.

In various embodiments of systems, and as illustrated in FIG. 1, thephysical mechanisms for generating thermal bubbles can comprise: (1)selective absorption of ultrasound energy within a bubbly medium due toenhanced attenuation from scattering; (2) enhanced thermal gradient in amicro-bubble rich region due to enhanced viscous losses from stablecavitation; (3) enhanced thermal response due to ultrasound-gas-vaporvoids; and/or (4) enhanced deposition of thermal energy from inertialcavitation events.

Each one of these mechanisms can be modulated either individually orused in combination with a thermal tissue effect. In variousembodiments, the source frequency is between 1 kHz-100 MHz, 5 kHz-50MHz, and/or 10 kHz-30 MHz (e.g., about 1 kHz-50 kHz, 50 kHz-100 kHz, 100kHz-500 kHz, 500 kHz-1 MHz, 1 MHz-10 MHz, and/or 10 MHz-30 MHz, oroverlapping ranges therein).

In various embodiments, the activation source powers are dependent onthe frequency, bubble size distribution, bubble density and tissue. Forexample, in some embodiments, the lower the frequency, the less intensefield is required to initiate thermal bubble activity. In someembodiments, the higher the nominal bubble size, the lower the sourcefrequency at which the gas bodies will resonate. In some embodiments,the higher the local concentration of gas bodies, the greater effectwith thermal bubbles can be achieved.

A wide range of transducer design configurations are used in accordancewith several embodiments, as further discussed below. These thermalbubble effects can also be leveraged to augmented imaging and treatmentmonitoring.

The methods and systems according to several embodiments disclosedherein contemplate the use of unfocused, focused, or defocused acousticenergy at variable spatial and/or temporal energy settings, in the rangeof about 1 kHz-100 MHz (e.g., about 1 kHz-50 kHz, 50 kHz-100 kHz, 100kHz-500 kHz, 500 kHz-1 MHz, 1 MHz-10 MHz, 10 MHz-30 MHz, and/or 30MHz-100 MHz, or overlapping ranges therein), and at variable tissuedepths. The unique ability to customize acoustic energy output andtarget a particular region of interest makes possible highly accurateand precise thermal bubble formation.

In several embodiments, the energy is acoustic energy. In otherembodiments, the energy is photon based energy (e.g., IPL, LED, laser,white light, etc., or combinations thereof), or other energy forms, suchradio frequency electric currents (including monopolar and bipolarradio-frequency current). In an embodiment, the energy is variouscombinations of acoustic energy, photon based energy, electromagneticenergy and other energy forms or energy absorbers such as cooling.

One or more of a transducer and/or transduction element configuration, alens, and mechanical movement of a transducer may facilitate targetingof a particular region of interest and/or thermal bubble formation atspecific locations.

In accordance with a method according to several embodiments, thermalbubbles act as contrast agents (e.g., markers or boundaries) forultrasound imaging and therapy. In this manner, a region of interest canbe marked or defined such that acoustic energy can be locally applied atfor example, a cell, tissue, gland, fiber, or tumor. A boundary can bein any two-dimensional or three-dimensional configuration suitable fordefining a region of interest for acoustic energy deposition (e.g.,circle, square, triangle, sphere, cube, cone, or any arbitrary shape).The acoustic energy deposited therein may be for any therapeutic purposenow known or later devised (e.g., for ablative or non-ablativepurposes).

In accordance with another method, just as thermal bubbles are used asboundaries for acoustic energy inclusion, as described herein, thermalbubbles can be used as boundaries for acoustic energy exclusion. Inother words, thermal bubbles can be used to protect or to avoid variouscells, tissues, glands, fibers, and/or regions of even higher acousticimpedance or sensitivity, for example. In some embodiments, bubbles areused to partially or fully isolate a region of interest.

Because thermal bubbles exhibit high acoustic impedance, in accordancewith some embodiments of a method, they are used to concentrate acousticenergy deposition within a region of interest. For example, thermalbubbles may be created in such a manner so as to “funnel” acousticenergy as it moves from the energy source to the region of interest,thereby concentrating acoustic energy at the deposition site. Anacoustical impedance mismatch can be created between the thermal bubbleand the surround tissue. This acoustical mismatch can cause acousticenergy traveling through tissue to reflect, deflect, and/or scatter uponcontact with the thermal bubble.

In various embodiments, a method of providing non-invasive ultrasoundtreatment, can comprise coupling an acoustic source to a surface ofskin; providing a first acoustic energy into a region of interest belowthe surface; creating thermal bubbles in a first portion of the regionof interest; providing a second acoustic energy into a second portion ofthe region of interest; and stimulating a bio-effect in the secondportion of the region of interest.

In one embodiment, the method can comprise forming a boundary comprisingthe thermal bubbles. In one embodiment, the method can comprisereflecting a portion of the second acoustic energy off of at least oneof the thermal bubbles. In one embodiment, the method can comprisedirecting the portion of the second portion of the second acousticenergy away from tissue outside of the region of interest from thesecond acoustic energy. In one embodiment, the method can compriseprotecting the tissue outside of the region of interest from the secondacoustic energy. In one embodiment, the tissue outside of the region ofinterest comprises an internal organ. In one embodiment, the method cancomprise directing the portion of the second portion of the secondacoustic energy into the second portion of the region of interest.

In one embodiment, the method can comprise scattering at least a portionof the second acoustic energy. In one embodiment, the method cancomprise concentrating the second acoustic energy into the secondportion of the region of interest. In one embodiment, the method cancomprise controlling a size of the thermal bubbles. In one embodiment,the method can comprise increasing a temperature of the first portion ofthe region of interest. In one embodiment, the method can comprisecontrolling a size of the thermal bubbles. In one embodiment, the methodcan comprise surrounding the second portion of the region of interestwith the boundary.

In one embodiment, the method can comprise creating a thermal lesion inthe second portion of the region of interest. In one embodiment, themethod can comprise cosmetically enhancing the skin. In one embodiment,the method can comprise treating the region of interest. In oneembodiment, the method the stimulating a bio-effect in the secondportion of the region of interest is reducing a volume of tissue. In oneembodiment, the method can comprise tightening a portion of the surfaceof the skin. In one embodiment, the method can comprise providing athird acoustic energy to region of interest. In one embodiment, themethod can comprise stimulating a second bio-effect in the region ofinterest.

In various embodiments, a method of cosmetic enhancement can comprisecoupling at least one source to a region of interest; directing a firstenergy into the region of interest; creating a plurality of thermalbubbles in at least one of the region of interest and a non-targetregion; directing a second energy into the region of interest; andenhancing at least a portion of the region of interest.

In one embodiment, the at least one source comprises an ultrasoundsource and a pulsed laser. In one embodiment, the first energy is atleast one of photon based energy and ultrasound energy. In oneembodiment, the second energy is at least one of photon based energy andultrasound energy. In one embodiment, the method can further compriseablating tissue in the region of interest.

In one embodiment, the method can comprise tightening skin on a surfaceof the region of interest. In one embodiment, the method can compriseintroducing a chemical moiety configured to enhance the creating theplurality of thermal bubbles. In one embodiment, the method can compriseimaging at least a portion of the region of interest. In one embodiment,the method can comprise locating the plurality of thermal bubbles. Inone embodiment, the method can comprise reflecting the second energy offof at least one of the thermal bubbles.

In various embodiments, a method of treating tissue can compriseproviding a first energy into a region of interest; creating at leastone thermal bubble in the region of interest; providing a second energyinto the region of interest; modulating the second energy; andcontrolling a size of the at least one thermal bubble.

In one embodiment, the method can comprise increasing the size of the atleast one thermal bubble. In one embodiment, the method can compriseoscillating between a first size and a second size of the at least onethermal bubble. In one embodiment, the method can comprise stimulating abio-effect in the region of interest. In one embodiment, the method cancomprise inserting a plurality of bubbles into the region of interest.In one embodiment, the method can comprise increasing a temperaturewithin the region of interest. In one embodiment, the method cancomprise stimulating a therapeutic effect within the region of interest.In one embodiment, the method can comprise providing a third energy intothe region of interest. In one embodiment, the method can comprisethermally injuring a portion of tissue in the region of interest. In oneembodiment, the method can comprise cosmetically enhancing at least aportion of the region of interest.

In accordance with some methods, thermal bubbles are also particularlyuseful in preferential heating applications. For example, various cells,tissues, glands, fibers, and tumors can be either directly or indirectlytherapeutically benefited by increases in temperature. And varioustherapeutic treatments, such as drug delivery, are facilitated byincreases in temperature. Heating applications may be carried out aloneor in combination with other thermal bubble applications and/orultrasound imaging or therapy.

As mentioned above, collapse of cavitation bubbles can generate shockwaves capable of disrupting cells and tissues and can induce chemicalchanges in the surrounding medium (e.g., generate highly reactivespecies, such as free radicals). Because some embodiments of the presentinvention enable highly accurate and precise thermal bubble formation,cells, tissues, glands, fibers, tumors, etc. can be selectivelydisrupted to accomplish various therapeutic applications, and variouschemical changes can be induced at specific locations.

As noted above, each one of the abovementioned thermal bubble mechanismscan be modulated either individually or used in combination with athermal tissue effect. In various embodiments, the combination effect ofthermal tissue effects with the use of thermal bubbles effectuatesand/or modulates a tissue response. In embodiments, use of bubbleeffects (inter-intracellular shear with a thermal tissue effect, e.g.,thermal gradient), activates a wound healing response, an immunehistological response, heat-shock protein expression and/or programmedcell death. In embodiments, tissue responses comprise wound debridement,keloid/scar healing, and increased localized micro-circulation.

In some embodiments, the thermal bubble response is maximized with theconcomitant use of micro-bubble based formulations, emulsifiers,saponificants and/or emulsions. Thermal bubble use with other chemicalmoieties (e.g., analgesics, topical anesthetics, antibiotics,antibacterials, antimicrobials retinoids, etc.) may be useful to (1)enhance their delivery and/or (2) to augment their activation.

In some embodiments, selective tissue effects are achieved with aselective thermal-bubble response within one or more tissues (such asdeep dermis, subcutaneous layers, etc). In other embodiments, selectivetissue responses are enhanced within one or more glandular structures(such as sebaceous gland, sweat gland, hair follicle, etc.), byinitiating a localized resonant cavity effect.

In accordance with some embodiments, optimization of therapy isaccomplished using concomitant monitoring of bubble activity, forexample, monitoring (a) one or more non-thermal responses (e.g., shear,inertial cavitation), (b) one or more thermal responses (e.g.,vaporization) and/or (c) one or more tissue property changes. Inaccordance with one aspect of an embodiment, monitoring of bubbleactivity comprises imaging.

In various embodiments, the methods and systems for generating thermalbubbles for improved ultrasound imaging and therapy comprise deliveringenergy to a region of interest (“ROI”) within one or more layers oftissue. As mentioned above, in an embodiment, the energy is acousticenergy. In other embodiments, the energy is photon based energy (e.g.,IPL, LED, laser, white light, etc.), or other energy forms, such radiofrequency electric currents (including monopolar and bipolarradio-frequency current). In an embodiment, the energy is variouscombinations of acoustic energy, photon-based energy, electromagneticenergy and other energy forms or energy absorbers such as cooling.

In various embodiments, systems and/or methods are configured to produceone or more bio-effects. The term “bio-effects”, as used herein, shallbe given its ordinary meaning and shall also mean biological effects andinclude, but not be limited to, effects on tissue (including in vivo, invitro, in situ and ex vivo tissue), cells, organs and other body parts.Bio-effects include, but are not limited to, incapacitating, partiallyincapacitating, severing, rejuvenating, removing, ablating,micro-ablating, shortening, manipulating, or removing tissue eitherinstantly or over time, and/or other effects, and/or combinationsthereof. Bio-effects include, but are not limited to, tissuemanipulation to e.g., facilitate aesthetic effects. Bio-effects alsoinclude, but are not limited to, tissue manipulation to e.g., enhancecollagen formation or healing. Various bio-effects are further disclosedin U.S. patent application Ser. No. 11/857,989 filed Sep. 19, 2007,published as US2008/0071255, which is incorporated in its entirety byreference, herein. In various embodiments, treatment of a specificsubcutaneous tissue to achieve a desired bio-effect uses ultrasoundenergy from system that may be directed to a specific depth within ROIto reach the targeted subcutaneous tissue. In one embodiment, abio-effect is cutting tissue. In one embodiment, for example, if it isdesired to cut muscle (by applying ultrasound energy at ablativelevels), which is a distance below the surface of the skin, ultrasoundenergy from ultrasound system may be provided at ROI at a level to reachabove, below, or approximately at the distance targeted at an ablativelevel which may be capable of ablating muscle.

In various embodiments, bio-effects may produce a clinical outcome suchas a brow lift which can comprise elevating the patient's eyebrows andreducing wrinkles on the patient's brow or forehead region. In someembodiments, the clinical outcome may be the same or similar totraditional invasive surgery techniques, and may comprise the removal ofwrinkles through a brow lift or replacement of treatment muscles and/orother tissue and subcutaneous tissue within the forehead (or otherregions on the body) with muscle relaxant drugs.

In various embodiments, wrinkles can be partially or completely removedby applying ultrasound energy at ROI along the patient's forehead atlevels causing the desired bio-effects. In various embodiments,bio-effects can comprise ablating, micro-ablating, coagulating,severing, partially incapacitating, shortening, removing, or otherwisemanipulating tissue or subcutaneous tissue to achieve the desiredeffect. In various embodiments, method can be used to ablate,micro-ablate, or coagulate a specific tissue, or can be used as part ofremoving the subcutaneous tissue. Further, in one embodiment, muscle(such as the corrugator supercilii muscle) can be paralyzed andpermanently disabled.

In various embodiments, systems and/or methods are configured toinitiate and/or stimulate one or more biological responses. In variousembodiments, biological responses can comprise, but are not limited to,diathermy, hemostasis, revascularization, angiogenesis, growth ofinterconnective tissue, tissue reformation, ablation of existing tissue,protein synthesis and/or enhanced cell permeability. Two or more ofthese biological responses may be combined to facilitate rejuvenationand/or treatment of superficial tissue. In various embodiments,responses to embodiments of systems or embodiments of methods areinitiated and/or stimulated by effects can include any biologicalresponse initiated and/or stimulated by energy effects, such as, forexample: 1) hemostasis, including that stimulated from concentratedultrasound, 2) subsequent revascularization/angiogenesis, such as thatgenerated from high frequency applications of approximately 2 MHz to 7MHz or more, 3) growth of interconnective tissue, 4) reformation and/orablation of existing tissue such as fat, collagen and others, 5)increased cell permeability that may facilitate the possibility ofstimulated gene or medication therapy to tissue, and/or increasedpermeability of certain tissues to a variety of medications initiated byultrasound frequencies 10 kHz to 10 MHz, 6) enhanced delivery and/oractivation of medicants, 7) stimulation of protein synthesis and/or 8)any other possible tissue response such as coagulative necrosis. Thus,for example, in various embodiments, a low intensity dispersedultrasound field can be generated to provide for angiogenesis, anincreased intensity homogeneous or uniform ultrasound field can begenerated to provide for diathermy that increases the rate of healingand rejuvenation, and/or high intensity focused and/or unfocused beamscan be generated to provide for temporary ablative and hemostaticeffects in a variety of depth and positions of human tissue, whereby asummation or a combined effect of rejuvenation is created by combiningultrasound energy fields.

With reference to FIG. 1, in various embodiments, ROI 12 is locatedwithin one of the nonviable epidermis (i.e., the stratum corneum), theviable epidermis, the viable dermis, the subcutaneous connective tissueand fat, and the muscle. Further, while only ROI 12 is illustrated, aplurality of ROIs can be treated, and in some embodiments, treatedsimultaneously. For example, ROI 12 may consist of or comprise of one ormore organs or a combination of tissues or subcutaneous tissues, whichare either superficial or located deep within the body.

In an embodiment, with reference to FIG. 2, an ultrasound system 14,comprising a control system 20, a probe 18, and a display system 22, isused to deliver first energy 4 and second energy 6 to at least a portionof ROI 12, such as, for example one or more of stratum corneum 85,viable epidermis 86, viable dermis 88, subcutaneous connective tissueand fat 82, and muscle 84. In various embodiments, at least one of firstenergy 4 and second energy 6 is provided by an acoustic transducer. Inone embodiment, first energy 4 and second energy 6 are two differentforms of ultrasound energy.

With continued reference to FIG. 2, in various embodiments, a probe 18is a transducer that delivers first energy 4 and second energy 6 to ROI12. Either or both of first energy 4 and second energy 6 may be used toproduce thermal bubbles 8 or provide ultrasound imaging or therapy. Forexample, acoustic energy 4 might create a thermal bubble 8 marker orboundary, or “funnel,” while acoustic energy 6 provides ultrasoundtherapy .directed to the marker or within the boundary.

In an embodiment, suction is used to attach probe 18 to the patient'sbody. In this embodiment, a negative pressure differential is created,which enables, probe 18 to attach to stratum corneum 85 by suction. Avacuum-type device can be used to create the suction and the vacuumdevice can be integral with, detachably connected to, or completelyseparate from probe 18. Using suction to attach probe 18 to stratumcorneum 85 I ensures that probe 18 is properly coupled to stratumcorneum 85. Further, using suction to attach probe 18 also reduces thethickness of the tissue to make it easier to reach distinct layers oftissue.

Turning now to the embodiments illustrated in FIG. 3, a system 14 may becapable of emitting ultrasound energy that is focused, unfocused ordefocused to treat skin and/or subcutaneous tissue within ROI 12. System14 may comprise a probe 18, a control system 20, and a display 22.System 14 may be used to delivery energy to, and/or monitor, ROI 12.

With reference to FIGS. 4A-4E, illustrates various embodiments of anacoustic transducer 19 capable of emitting ultrasound energy. This mayheat ROI 12 at a specific depth to target a specific tissue orsubcutaneous tissue causing that tissue to be ablated, micro-ablated,coagulated, incapacitated, partially incapacitated, rejuvenated,shortened, paralyzed, or removed.

A coupling gel may be used to couple probe 18 to ROI 12 at a surface ofstratum corneum 85, for example, a surface of a patient's skin.Ultrasound energy may be emitted in various energy fields in thisembodiment. With additional reference to FIG. 4A and FIG. 4B and in thisembodiment, the energy fields may be focused, defocused, and/or madesubstantially planar by transducer 19, to provide many differenteffects. Energy may be applied in a C-plane or C-scan. For example, inone embodiment, a substantially planar energy field may provide aheating and/or pretreatment effect, a focused energy field may provide amore concentrated source of heat or hypothermal effect, and anon-focused energy field may provide diffused heating effects. It shouldbe noted that the term “non-focused” as used throughout encompassesenergy that is unfocused or defocused.

In another embodiment, a transducer 19 may be capable of emittingultrasound energy for imaging or treatment or combinations thereof. Inan embodiment, transducer 19 may be configured to emit ultrasound energyat specific depths in ROI 12 to target a specific tissue. In thisembodiment, transducer 19 may be capable of emitting unfocused ordefocused ultrasound energy over a wide area in and/or around ROI 12 fortreatment purposes.

In various embodiments, a transducer 19 may comprise one or moretransduction elements 26 for facilitating treatment. Transducer 19 mayfurther comprise one or more transduction elements 26, such as, forexample, elements 26A and 26B as illustrated in FIGS. 4A and 4B. One ormore transduction elements 26 may comprise piezoelectrically activematerial, such as lead zirconante titanate (PZT), or otherpiezoelectrically active material such as, but not limited to, apiezoelectric ceramic, crystal, plastic, and/or composite materials, aswell as lithium niobate, lead titanate, barium titanate, and/or leadmetaniobate. In addition to, or instead of, a piezoelectrically activematerial, one or more transduction elements 26 may comprise any othermaterials configured for generating radiation and/or acoustical energy.Transducer 19 may also comprise one or more matching and/or backinglayers coupled to the piezoelectrically active material of the one ormore transduction elements 26. Transducer 19 may also be configured withsingle or multiple damping elements along the one or more transductionelement 26.

In an embodiment, the thickness of the transduction element 26 oftransducer 19 may be configured to be uniform. That is, the transductionelement 26 may be configured to have a thickness that is generallysubstantially the same throughout.

In another embodiment, the transduction element 26 may also beconfigured with a variable thickness, and/or as a multiple dampeddevice. For example, the transduction element 26 of transducer 19 may beconfigured to have a first thickness selected to provide a centeroperating frequency of a lower range, for example from approximately 1kHz to 3 MHz. The transduction element 26 may also be configured with asecond thickness selected to provide a center operating frequency of ahigher range, for example from approximately 3 to 100 MHz or more.

In yet another embodiment, transducer 19 may be configured as a singlebroadband transducer excited with two or more frequencies to provide anadequate output for raising the temperature within ROI 12 to the desiredlevel. Transducer 19 may also be configured as two or more individualtransducers, wherein each transducer 19 may comprise a transductionelement 26. The thickness of the transduction elements 26 may beconfigured to provide center-operating frequencies in a desiredtreatment range. For example, in an embodiment, transducer 19 maycomprise a first transducer 19 configured with a first transductionelement 26A having a thickness corresponding to a center frequency rangeof approximately 1 MHz to 3 MHz, and a second transducer 19 configuredwith a second transduction element 26B having a thickness correspondingto a center frequency of approximately 3 MHz to 100 MHz or more. Variousother ranges of thickness for a first and/or second transduction element26 can also be realized.

Moreover, in an embodiment, any variety of mechanical lenses or variablefocus lenses, e.g. liquid-filled lenses, may also be used to focus andor defocus the energy field. For example, with reference to theembodiments depicted in FIGS. 4A and 4B, transducer 19 may also beconfigured with an electronic focusing array 24 in combination with oneor more transduction elements 26 to facilitate increased flexibility intreating ROI 12. Focusing array 24 may be configured as an array ofelectronic apertures that may be operated by a variety of phases viavariable electronic time delays, for example, T 1, T 2, T 3 . . . Tj. Bythe term “operated,” the electronic apertures of array 24 may bemanipulated, driven, used, and/or configured to produce and/or deliverenergy in a manner corresponding to the phase variation caused by theelectronic time delay. For example, these phase variations may be usedto deliver defocused beams, planar beams, and/or focused beams, each ofwhich may be used in combination to achieve different physiologicaleffects in ROI 12.

In various embodiments, transduction elements 26 may be configured to beconcave, convex, and/or planar. For example, in the embodimentillustrated in FIG. 4A, transduction elements 26A and 26B are configuredto be concave in order to provide focused energy for treatment within atleast a portion of ROI 12. Additional embodiments are disclosed in U.S.patent application Ser. No. 10/944,500, entitled “System and Method forVariable Depth Ultrasound Treatment,” incorporated herein by referencein its entirety.

In another embodiment, as illustrated in FIG. 4B, transduction elements26A and 26B may be configured to be substantially flat in order toprovide substantially uniform energy to ROI 12. While FIGS. 4A and 4Billustrate embodiments with transduction elements 26 configured asconcave and substantially flat, respectively, transduction elements 26may be configured to be concave, convex, and/or substantially flat. Inaddition, transduction elements 26 may be configured to be anycombination of concave, convex, and/or substantially flat structures.For example, a first transduction element 26 may be configured to beconcave, while a second transduction element 26 may be configured to besubstantially flat.

Moreover, transduction element 26 can be any distance from the patient'sskin. In that regard, it can be far away from the skin disposed within along transducer or it can be just a few millimeters from the surface ofthe patient's skin. In certain embodiments, the transduction element 26can be positioned closer to the surface of a patient's skin whenemitting ultrasound at high frequencies. Moreover, both three and twodimensional arrays of elements can be used in the present invention.

With reference to FIGS. 4C and 4D, transducer 19 may also be configuredas an annular array to provide planar, focused and/or defocusedacoustical energy. For example, in an embodiment, an annular array 28may comprise a plurality of rings 30, 32, 34 to N. Rings 30, 32, 34 to Nmay be mechanically and electrically isolated into a set of individualelements, and may create planar, focused, or defocused waves. Forexample, such waves can be centered on-axis, such as by methods ofadjusting corresponding transmit and/or receive delays, T 1, T 2, T 3 .. . TN. An electronic focus may be suitably moved along various depthpositions, and may enable variable strength or beam tightness, while anelectronic defocus may have varying amounts of defocusing. In anembodiment, a lens and/or convex or concave shaped annular array 28 mayalso be provided to aid focusing or defocusing such that any timedifferential delays can be reduced. Movement of annular array 28 in one,two or three-dimensions, or along any path, such as through use ofprobes and/or any conventional robotic arm mechanisms, may beimplemented to scan and/or treat a volume or any corresponding spacewithin ROI 12.

With reference to FIG. 4E, another embodiment of a transducer 19 can beconfigured to comprise a spherically focused single element 36,annular/multi-element 38, annular with imaging region(s) 40,line-focused single element 42, 1-D linear array 44, 1-D curved(convex/concave) linear array 46, and/or 2-D array 48, combined withmechanical focus 50, convex lens focus 52, concave lens focus 54,compound/multiple lens focused 56, and/or planar array form 58 toachieve focused, unfocused, or defocused sound fields for at least oneof imaging and therapy.

Transducer 19 may further comprise a reflective surface, tip, or area atthe end of the transducer 19 that emits ultrasound energy. Thisreflective surface may enhance, magnify, or otherwise change ultrasoundenergy emitted from system 14.

In various embodiments, a probe 18 may be suitably controlled andoperated in various manners by control system 20 as illustrated in FIGS.2, 3 and 5A-5C which processes and sends one or more images obtained bytransducer 19 to display 22. In the embodiment illustrated in FIGS.5A-5C, control system 20 may be capable of coordination and control ofthe entire treatment process to achieve the desired effect on tissuewithin ROI 12. For example, in an embodiment, control system 20 maycomprise power source components 60, sensing and monitoring components62, cooling and coupling controls 64, and/or processing and controllogic components 66. Control system 20 may be configured and optimizedin a variety of ways with more or less subsystems and components toimplement the system 14 for controlled targeting of the desired tissuein ROI 12.

For example, in various embodiments of power sourcing components 60,control system 20 may comprise one or more direct current (DC) powersupplies 68 capable of providing electrical energy for the entirecontrol system 20, including power required by a transducer electronicamplifier/driver 70. A DC current sense device 72 may also be providedto confirm the level of power entering amplifiers/drivers 70 for safetyand monitoring purposes, among others.

In an embodiment, amplifiers/drivers 70 may comprise multi-channel orsingle channel power amplifiers and/or drivers. In an embodiment fortransducer array configurations, amplifiers/drivers 70 may also beconfigured with a beamformer to facilitate array focusing. In variousembodiments, a beamformer may be electrically excited by anoscillator/digitally controlled waveform synthesizer 74 with relatedswitching logic.

Power sourcing components 60 may also comprise various filteringconfigurations 76. For example, switchable harmonic filters and/ormatching may be used at the output of amplifier/driver 70 to increasethe drive efficiency and effectiveness. Power detection components 78may also be included to confirm appropriate operation and calibration.For example, electric power and other energy detection components 78 maybe used to monitor the amount of power entering probe 18.

Various sensing and monitoring components 62 may also be suitablyimplemented within control system 20. For example, in an embodiment,monitoring, sensing, and interface control components 80 may be capableof operating with various motion detection systems implemented withinprobe 18, to receive and process information such as acoustic or otherspatial and temporal information from ROI 12. Sensing and monitoringcomponents 62 may also comprise various controls, interfacing, andswitches 82 and/or power detectors 78. Such sensing and monitoringcomponents 62 may facilitate open-loop and/or closed-loop feedbacksystems within treatment system 14.

In an embodiment, sensing and monitoring components 62 may furthercomprise a sensor that may be connected to an audio or visual alarmsystem to prevent overuse of system 14. In this embodiment, the sensormay be capable of sensing the amount of energy transferred to the skin,and/or the time that system 14 has been actively emitting energy. When acertain time or temperature threshold has been reached, the alarm maysound an audible alarm, or cause a visual indicator to activate to alertthe user that a threshold has been reached. This may prevent overuse ofthe system 14. In an embodiment, the sensor may be operatively connectedto control system 20 and force control system 20, to stop emittingultrasound energy from transducer 19.

In an embodiment, a cooling/coupling control system 84 may be provided,and may be capable of removing waste heat from probe 18. Furthermore thecooling/coupling control system 84 may be capable of providing acontrolled temperature at the superficial tissue interface and deeperinto tissue, and/or provide acoustic coupling from probe 18 to ROI 12.Such cooling/coupling control systems 84 can also be capable ofoperating in both open-loop and/or closed-loop feedback arrangementswith various coupling and feedback components.

Additionally, in various embodiments, an control system 20 may furthercomprise a system processor and various digital control logic 86, suchas one or more of microcontrollers, microprocessors, field-programmablegate arrays, computer boards, and associated components, includingfirmware and control software 88, which may be capable of interfacingwith user controls and interfacing circuits as well as input/outputcircuits and systems for communications, displays, interfacing, storage,documentation, and other useful functions. System software 88 may becapable of controlling all initialization, timing, level setting,monitoring, safety monitoring, and all other system functions requiredto accomplish user-defined treatment objectives. Further, variouscontrol switches 90 may also be suitably configured to controloperation.

With reference to FIG. 5C, in various embodiments, a transducer 19 maybe controlled and operated in various manners by a hand-held formatcontrol system 92. An external battery charger 94 can be used withrechargeable-type batteries 96 or the batteries can be single-usedisposable types, such as AA-sized cells. Power converters 98 producevoltages suitable for powering a driver/feedback circuit 100 with tuningnetwork 102 driving transducer 19 which is coupled to the patient viaone or more acoustic coupling caps 104. Cap 104 can be composed of atleast one of a solid media, semi-solid e.g. gelatinous media, and/orliquid media equivalent to an acoustic coupling agent (contained withina housing). Cap 104 is coupled to the patient with an acoustic couplingagent 106. In addition, a microcontroller and timing circuits 108 withassociated software and algorithms provide control and user interfacingvia a display 110, oscillator 112, and other input/output controls 114such as switches and audio devices. A storage element 116, such as anElectrically Erasable Programmable Read-Only Memory (“EEPROM”), secureEEPROM, tamper-proof EEPROM, or similar device holds calibration andusage data. A motion mechanism with feedback 118 can be suitablycontrolled to scan the transducer 19, if desirable, in a line ortwo-dimensional pattern and/or with variable depth. Other feedbackcontrols comprise a capacitive, acoustic, or other coupling detectionmeans and/or limiting controls 120 and thermal sensor 122. A combinationof the secure EEPROM with at least one of coupling caps 104, transducer19, thermal sensor 122, coupling detectors, or tuning network. Finally,a transducer can further comprise a disposable tip 124 that can bedisposed of after contacting a patient and replaced for sanitaryreasons.

With reference again to FIGS. 2, 3, and 5, in various embodiments, asystem 14 also may comprise display 22 capable of providing images ofROI 12 in certain embodiments where ultrasound energy may be emittedfrom transducer 19 in a manner suitable for imaging. In an embodiment,display 22 is a computer monitor. Display 22 may be capable of enablingthe user to facilitate localization of the treatment area andsurrounding structures, e.g., identification of subcutaneous tissueand/or internal organs. In an alternative embodiment, the user may knowthe location of the specific target below a skin surface, which is to betreated. After localization, ultrasound energy is delivered at a depth,distribution, timing, and energy level to achieve the desired effectwithin ROI 12. Before, during and/or after delivery of ultrasoundenergy, monitoring of the treatment area and surrounding structures maybe conducted to further plan and assess the results and/or providefeedback to control system 20, and to a system operator via display 22.In an embodiment, localization may be facilitated through ultrasoundimaging that may be used to define the position of a target within ROI12.

In various embodiments, for ultrasound energy delivery, transducer 19may be mechanically and/or electronically scanned to place treatmentzones over an extended area in ROI 12. A treatment depth may be adjustedbetween a range of approximately 1 to 30 millimeters, or any other depthdescribed herein. Such delivery of energy may occur through imaging ofthe target, within ROI 12 and then applying ultrasound energy at knowndepths over an extended area without initial or ongoing imaging.

In various embodiments, the ultrasound beam from transducer 19 may bespatially and/or temporally controlled at least in part by changing thespatial parameters of transducer 19, such as the placement, distance,treatment depth and transducer 19 structure, as well as by changing thetemporal parameters of transducer 19, such as the frequency, driveamplitude, and timing, with such control handled via control system 20.Such spatial and temporal parameters may also be suitably monitoredand/or utilized in open-loop and/or closed-loop feedback systems withinultrasound system 14.

Finally, it should be noted that while this disclosure is directedprimarily to using ultrasound energy to conduct proceduresnon-invasively, that the method and system described above can alsoutilize energy such as ultrasound energy to assist in invasiveprocedures. For example, ultrasound energy can be used to ablate tissuesduring an invasive procedure. In this regard, ultrasound energy can beused for invasive and minimally invasive procedures.

The present invention has been described herein with reference tovarious embodiments. However, those skilled in the art will recognizethat changes and modifications may be made to any of the variousembodiments without departing from the scope of the invention. Forexample, the various operational steps, as well as the components forcarrying out the operational steps, may be implemented in alternate waysdepending upon the particular application or in consideration of anynumber of cost functions associated with the operation of the system,for example, various of the steps may be deleted, modified, or combinedwith other steps.

Further, it should be noted that while the methods and systems forultrasound treatment, as described herein, are suitable for use by amedical practitioner proximate the patient, the system can also beaccessed remotely, for example, the medical practitioner can viewthrough a remote display having imaging information transmitted invarious manners of communication, such as by satellite/wireless or bywired connections such as IP or digital cable networks and the like, andcan direct a local practitioner as to the suitable placement for thetransducer. Moreover, while the various embodiments may comprisenon-invasive configurations, systems and methods can also be configuredfor at least some level of invasive treatment applications.

The various embodiments, as disclosed and illustrated herein, are not tobe considered in a limiting sense as numerous variations are possible.The subject matter of the various embodiments of the invention includesany and all novel and non-obvious combinations and sub combinations ofthe various elements, features, functions and/or properties disclosedherein. These and other changes or modifications are intended to beincluded within the scope of the present invention, as set forth in thefollowing claims.

What is claimed is:
 1. A method of providing non-invasive ultrasoundtreatment, the method comprising: coupling an acoustic source to asurface of skin; providing a first acoustic energy into a region ofinterest below the surface; creating thermal bubbles in an outer portionof the region of interest; forming a boundary comprising the thermalbubbles in the outer portion of the region of interest, therebysurrounding an inner portion of the region of interest with theboundary; providing a second acoustic energy into the inner portion ofthe region of interest; and containing the second acoustic energy withinthe boundary, wherein the second acoustic energy stimulates a bio-effectin the inner portion of the region of interest.
 2. The method accordingto claim 1, further comprising reflecting a portion of the secondacoustic energy off of at least one of the thermal bubbles in theboundary and directing a reflected portion of the second acoustic energyinto the inner portion of the region of interest.
 3. The methodaccording to claim 2, further comprising directing the portion of thesecond portion of the second acoustic energy away from tissue outside ofthe region of interest.
 4. The method according to claim 3, furthercomprising protecting the tissue outside of the region of interest fromthe second acoustic energy.
 5. The method according to claim 4, wherein,the tissue outside of the region of interest comprises an internalorgan.
 6. The method according to claim 2, further comprising scatteringthe reflected portion of the second acoustic energy into the innerportion of the region of interest.
 7. The method according to claim 2,further comprising concentrating the second acoustic energy into theinner portion of the region of interest.
 8. The method according toclaim 1, wherein the bio-effect in the inner portion of the region ofinterest is reducing a volume of tissue.
 9. The method according toclaim 1, further comprising tightening a portion of the surface of theskin.
 10. The method according to claim 1, further comprising ablating aportion of tissue in the inner portion of the region of interest. 11.The method according to claim 1, wherein the second energy does notcreate cavitation in the inner portion of the region of interest. 12.The method according to claim 1, wherein the bio-effect in the secondinner portion of the region of interest is enhancing formation ofcollagen in the region of interest.
 13. A method of cosmeticenhancement, the method comprising; coupling at least one source to aregion of interest; directing a first energy from the at least onesource into the region of interest; creating a boundary comprising aplurality of thermal bubbles in a non-target region with the firstenergy, thereby surrounding a target region in the region of interestwith the boundary; and directing a second energy from the at least onesource inside the boundary and into the target region in the region ofinterest; wherein the second energy stimulates a bio-effect in at leasta portion of the target region.
 14. The method according to claim 13,wherein the at least one source comprises an ultrasound source and apulsed laser.
 15. The method according to claim 13, wherein the firstenergy is ultrasound energy and the second energy is photon-basedenergy.
 16. The method according to claim 13, wherein the first energyis ultrasound energy and the second energy is ultrasound energy.
 17. Themethod according to claim 13, wherein the second energy does not createcavitation in the inner portion of the target region.
 18. The methodaccording to claim 13, further comprising reflecting a portion of thesecond energy off of at least one of the thermal bubbles in the boundaryand directing a reflected portion of the second energy into the targetregion.
 19. The method according to claim 18, further comprisingconcentrating the second energy into the target region.
 20. The methodaccording to claim 13, wherein the second energy ablates tissue in thetarget region.
 21. The method according to claim 13, wherein thebio-effect in at least a portion of the target region is rejuvenatingtissue in the target region.